Further Details On The New Health Insurance Premium Assistance Bill

One of the changes being pushed by the liberals would lower the age of eligibility for Medicare to 55, from 65. Another would expand Medicaid to cover people with incomes up to 150 percent of the poverty level (up to $33,075 for a family of four). The Senate bill, as it now stands, would expand Medicaid to cover people up to 133 percent of the poverty level ($29,327 for a family of four.)

A third liberal proposal would require insurers to spend a specified share of premiums — about 90 percent — on clinical services and activities that improve the quality of care. This would, in effect, limit the profits that insurers could make. [ . . .] Senator Sherrod Brown, Democrat of Ohio, is taking the lead in drafting the proposal to let people 55 to 64 “buy into” Medicare. In May, Senator John D. Rockefeller IV, Democrat of West Virginia, introduced a bill to provide access to Medicare for people in that age group. “I’ve been for that since 2001,” he said.

(Emphasis supplied.) I hope Senators Brown and Rockefeller are writing a provision that states that anyone of any age subject to the mandate (which means everyone who goes into the Exchange) will have the Medicare buy-in option. Otherwise, the mandate should be scrapped. Another possibility, it seems to me, would be to allow states to opt out of allowing their residents to buy in to Medicare. I'm sure North Dakotans will appreciate that.

not going to have to wait until it actually kicks in. The GOP is going to remind everyone how bad this reform is and I believe it's bad enough for the GOP to ride it to the White House in 2012. It may never take effect if that happens.

buy into Medicare is not only the public option--it's better than the public option. Naturally, that's a compromise I will accept. That should have been part of the politics of this in the first place IMO. (Who doesn't love Medicare?)

in light of widely recognized student loan debt and the unemployment hitting recent college graduates in particular, it would be helpful to allow people under the age of 30 to also buy into Medicare. Ahem...

wants those younger people to increase their profits. Insurance pools consisting of people under 55 and a captive audience of those 18 - 25 will do much to help their bottom line. The true story of this health insurance initiative is that whatever the insurance industry wants, the insurance industry will get.

if it's not universal (or almost universal) access. I am especially concerned about loading up Medicare with the next worse risk pool, making it even more difficult to expand in the future (because it looks even more expensive than it is now).

ten years at the bottom would provide a diverse pool which could offer health care at the most affordable rate. Since the insurance industry wants the bottom bracket to raise their profits, that will not IMO happen.

Not all employer-provided insurance is equal. I have no doubt that most people who have it will keep it, but under the status quo, you don't have the sword of Damocles (i.e. the mandate) hanging over you on the chance that you get fired.

People worry all the time about losing their health insurance coverage if they get fired. No one is saying "gee, I sure hope I retain the right to go without health insurance if I get fired."

If there's heavily subsidized insurance available for people who lose their job, that's a huge plus. You'll find very few people who are like, "But, but, but, there's a MANDATE for me to buy that heavily subsidized insurance."

It is the subsidy that is make or break. Obviously a mandate is disastrous without a public option or subsidies, no one disputes that.

employed by an employer who has over 10 or 20 employees, than you are forced to buy into the employer's policy (and for some people that it quite a big buy-in once you calculate the employee contributions, co-pays, etc. etc.).

That's different from what you are saying. What you are saying is more like what Obama has been saying, which was never particularly accurate.

1) they are forced to buy insurance due to the language in the bill; 2) by being employed by a larger employer are barred from the exchange, public option, medicare, etc.; and 3) while their employer's plan is not affordable, any other choices are even more expensive and thus not viable alternatives.

Thus, their choices are to buy into their employer's insurance or violate the law.

full circle (which is fine). I thought your larger point is that everyone who is subject to the mandate should be able to buy into Medicare. If the details are right, I could totally go along with that. But then you proceed to cut out most of the people are subject to the mandate. That's what I don't understand.

to people who have insurance not merely because I think it. What you or I think is irrelevant. It either does in the the bill or it doesn't. Which is it?

I know plenty of people who can't really afford the insurance that their employers offer (which, I understand, they are forced to purchase under the bill).

I don't buy the camel's nose theory. I'm more inclined to support the idea of an expansion of medicare rather than the creation of a wholly inadequate public option precisely because Medicare has been proven to work whereas there is no evidence that the public option as crafted in the bill would be effective or economically sustainable. Of course, the devil is in the details and likely the medicare expansion will be designed to fail.

But the above paragraph is only opinion (as your camel's nose theory is only an opinion). The only fact I was trying to clarify is who is subject to the mandate. My understand is that the bill subjects all Americans to the mandate. If that's not what it says in the bill, I'm happy to be corrected.

plenty of people make the choice every year as to whether they can afford their employer's health insurance. Under the new bill, those people won't have the choice. And, none one of those employees will have the choice to go outside of their employer's plan to choose to have medicare (another precedent to exclude people from publicly administered health insurance...the camel's nose can go both ways). So, it both applies and effects a lot more people than you are allowing for, IMO.

Each year I am given the opportunity to change my benefits profile at work (i.e. do I want to buy their insurance or not, do I want to add a spouse or dependent to the plan, etc.).

You do not ask your employees every year if they want cash payment instead of insurance, but if the insurance you offer includes a percentage to be paid by the employee, then if they choose not to buy into your plan they are effectively getting cash to use for another purpose.

if anyone is opting out just to receive a percentage of the cost of their insurance (how big a percentage are we talking about?), I suspect 99% of those people have insurance through a spouse or some other source. I certainly wouldn't assume that they "can't afford" their employer's insurance (meaning that if they didn't have the choice to opt out... they'd quit their job?)

"can't afford" I am saying that at minimum they are may be giving up something else that could be very important and necessary in their lives. So even if they choose to buy into the insurance, they are still suffering in other ways.

that percentage depends on the type and affordability of the insurance offered by your employer. And I would say that while it is probably low, it is by no means zero. Especially if you are a younger person whose employer offers cr@p insurance.

I think in order to apply a mandate to these people, you have to have some minimum threshold of what quialifies under "employer insurance". As in, if it costs more than "X" for the employee or offers less than "X" - they can buy into the "whatever government exchange/option/buy-in is available" before being subject to a mandate.

I worked at a small company once where over 50% of the employees did not buy-in, and most were not covered under other plans, because although insurance was offered, the employer didn't cover much of the cost and the insurance offered wasn't very good, and the average age of the employees was relatively low.

I don't know what to think about the sort of person who prefers no insurance coverage at all to mediocre coverage at a 50% discount, but I'm not convinced those people should be paramount in the thoughts of lawmakers. Again, if they get hit by a bus, who do they expect to pick up the medical bills?

I'm also not convinced that any of those people "can't afford" insurance by any reasonable definition of the term "can't afford."

Right now we're talking about hypotheticals, and you are assuming coverage and affordability are there under your definitions. But you don't actually know what they are. I think there needs to be a minimum threshold before we assume that people aren't choosing that option out of selfishness.

This link from a Walmart watch website is from 2005/2006 but I was actually surprised by this:

According to Wal-Mart's own website, "In January 2006, the number of associates covered by Wal-Mart health care insurance increased to 46%." [http://www.walmartfacts.com]
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Nationally, 67 percent of workers in large firms (200 employees or more) receive their health benefits from their employer. More than 80 percent of Costco workers are covered by their company plan. [Employer Health Benefits 2005 Annual Survey, The Kaiser Family Foundation and Health Research and Educational Trust; New York Times, 10/24/05]

Really? 67% of workers in large firms? I'm kind of surprised by that.

But I'm confused by the 25% refund data point. I must have missed something somewhere. Most employees who decline have other reasons. Generally either affordability or access to other insurance (for example spouse's family plan). Where is there a refund?

...is the only thing that gives money any value, whatever plan is passed had better engender the confidence of the vast majority of Americans or guess what? The value of the dollar will plunge further, the cost of healthcare will skyrocket more, and the cost of any public option that survives (especially one with a risky pool) will become even more costly and less responsive.

We still cannot stop treating money like the swallows of Capistrano. Money first, people second, that is our motto. And it is going to kill us.

is that if this is largley succuessful it further removes incentives for private insurers to pay for preventitive care (they already feel its pointless as it basically cuts costs post-65, drop it to 55 and things like Heart Disease, and Prostate Cancer become diseases that may not be cost-effective to screen for).